The FEMA COVID-19 Emergency Protective Measures Fact Sheet included a list of eligible emergency medical care activities. The eligibility of emergency medical care activities as an emergency protective measure under the Emergency Declaration and any Major Disaster Declaration authorizing Public Assistance (PA) for COVID-19 will be an evolving process. A guiding principle would be any increased operational costs related to Covid-19 should be considered for financial recovery. The challenge will be whether recovery will be FEMA Public Assistance Program or other Federal or State Covid-19 funding programs.
General Eligibility Considerations for Emergency Medical Care
Eligible emergency protective measures taken to respond to the COVID-19 emergency at the direction or guidance of public health officials may be reimbursed under the PA program. On March 19, 2020, FEMA released the COVID-19 Emergency Protective Measures Fact Sheet which outlines the types of emergency protective measures that may be eligible under the PA program in accordance with the COVID-19 Emergency Declaration.
General eligibility considerations for emergency medical care activities apply to all claimed work and associated costs. They include Applicant, Facility, Work, and Cost eligibility to which all claims are subject under the PA program.
SLTT government entities are eligible to apply for PA. Certain PNP organizations are eligible to apply for PA, including those that own and/or operate medical care facilities.
Private for profit entities, including for profit hospitals, are not eligible for assistance from FEMA under PA. SLTT government entities may contract with for profit hospitals to carry out eligible emergency protective measures. FEMA will reimburse the eligible Applicant for the cost of eligible work, and the Applicant will then pay the private entity for the provision of services.
For SLTT governments, evaluating facility eligibility is not necessary for most emergency work. PNPs are generally not eligible for reimbursement for emergency services because they are not legally responsible for providing those services.
PNPs that own or operate a medical or custodial care facility are eligible for:
Work must be necessary as a direct result of the emergency or major disaster (44 CFR §206.223(a)(1)).Costs must be directly related to COVID-19 cases. For example, emergency medical care costs related to a non-COVID-19 illness or injury are not eligible.
Costs for personal protective equipment (PPE) for health care providers who are working in a hospital treating COVID-19 patients are eligible, as it is necessary to prevent further spread of the virus and protect health care workers and other patients.
When the emergency medical delivery system within a declared area is destroyed, severely compromised, or overwhelmed, FEMA may fund extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care or expanding existing medical care capacity in response to the declared incident. Costs associated with emergency medical care should be customary for the emergency medical services provided. Other eligibility considerations specific to emergency medical care activities as an emergency protective measure under the COVID-19 Declarations are provided in this section.
Eligible Emergency Medical Care Activities When Depend on the Applicant Type (State, County, Local,etc) and their Legal Responsibility for the Emergency Services and Directions from Local and State Public Health Authorities. Eligible emergency response costs may include, but are not limited to the following examples:
Contracts
Equipment
Facilities
Medical Treatment & Actions
Medical Supplies
Medical Transport
Donated Resource
Current FEMA Guidance on Eligibility of Medical Expenses. Prior to the COVID-19 outbreak, FEMA had published guidance on which costs are, and are not, eligible for assistance when "the emergency medical delivery system within declared area is destroyed, severely compromised or overwhelmed."
The guidance emphasizes that FEMA funding is for "extraordinary"situations – which quite clearly describes the COVID-19 outbreak. FEMA's focus is on using funding only for temporary costs created by the declared event,such as "extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care of survivors…Costs are eligible for up to 30 days from the declaration date unless extended by FEMA." FEMA's Policy includes examples of eligible and ineligible work and costs and is available here at page 63.
When the emergency medical delivery system within a declared area is destroyed, severely compromised or overwhelmed, FEMAmay fund extraordinary costs associated with operating emergency rooms and with providing temporary facilities for emergency medical care of survivors. Costs associated with emergency medical care should be customary for the emergency medical services provided.
More examples of possible eligible emergency medical costs may include, but not limited to:
Labor
Medical sheltering (e.g., when existing facilities are reasonably forecasted to become overloaded in the near future and cannot accommodate needs)
During this process, it is necessary to get as much funding as possible to cover additional costs incurred by the extra time and effort put forth including the larger quantity of supplies being utilized. The recent passage of the Federal Stimulus Bill had three relief packages, the third of which is The Coronavirus Aid, Relief and Economic Security (CARES) Act, passed on March 25th. Under this package, healthcare organizations have the opportunity to submit their incremental costs to obtain relief funding. These are costs that are in addition to the normal operating costs that are either “COVID-19 related” or “COVID-19 induced”. For example, extra PPE supplies fall into the former and opening new units to cohort non-COVID-19 patients would fall into the latter category.
The good news is that substantial funding is available. However, governmental rules and requirements around this funding will require an extreme degree of specificity, documentation, organization, and comprehensiveness – in order to actually receive this relief funding. This is somewhat akin to clinical documentation. If organizations don’t record their expenditures with sufficient specificity and have the backup data to support the claims, they will not be paid the correct amount, the amount they deserve.
Procurement requirements differ between state versus non-state entities and by normal versus emergency/exigent circumstances. Procurement requirements for the COVID-19 Declarations are:
Emergency responses and urgent public health responses are critical priorities. However, financial disaster recovery from the Covid-19 Pandemic response actions will become an essential budget issue in light of reducing tax revenues and increased demand for services.
Accounting Considerations -Tracking and Managing Coronavirus Recovery Costs
Recognizing the logistical and bureaucratic challenges this unprecedented response effort will bring, FEMA is actively working to develop a simplified application and funding process. Your experience with the FEMA Public Assistance Covid-19 Simplified Grant Process will be materially less administratively painful with smoother quicker reimbursement of costs:
If you accurately track and document COVID-19 response expenditures,
It is essential to consistently use activity/cost codes for COVD19 on all purchases of material, labor, supplies, contracts, services, and equipment that are directly related to responding to the COVID-19 pandemic.
ü The cost coding systems used by your entity will depend on your supporting technology for operations accounting for payroll, materials/supplies, contracts, and purchasing order protocols.
FEMA Public Assistance program is a REIMBURSEMENT program.
Applicants for Public Assistance MUST TAKE IMMEDIATE PROACTIVE ACCOUNTING MEASURES
To help you proactively navigate the complex FEMA programs and track eligible costs incurred, the information available here is provided as a PUBLIC SERVICE so that you and your teams can better track Covid-19 disaster-related costs for financial recovery.
EMERGENCY COVID-19 RESPONSE FIRST, BUT TRACK & DOCUMENT COSTS
CONSISTENT COST TRACKING AND DOCUMENTATION OF COVID-19 RESPONSE COSTS WILL MAKE A REIMBURSEMENT DIFFERENCE
Emergency responses and urgent public health responses are critical priorities. However, financial disaster recovery from the Covid-19 Pandemic response actions will become an essential budget issue in light of reducing tax revenues and increased demand for services.
Accounting Considerations -Tracking and Managing Coronavirus Recovery Costs
Recognizing the logistical and bureaucratic challenges this unprecedented response effort will bring, FEMA is actively working to develop a simplified application and funding process.
Your experience with the FEMA Public Assistance Covid-19 Simplified Grant Process will be materially less administratively painful with smoother quicker reimbursement of costs, IF YOU
FEMA Public Assistance program is a REIMBURSEMENT program.
Applicants for Public Assistance MUST TAKE IMMEDIATE PROACTIVE ACCOUNTING MEASURES
To help you proactively navigate the complex FEMA programs and track eligible costs incurred, the information available here is provided as a PUBLIC SERVICE so that you and your teams can better track Covid-19 disaster-related costs for financial recovery.
IMPORTANT – ONLY FEMA CAN MAKE ELIGIBILITY AND COST DETERMINATIONS
The current FEMA PA Policy & Procedures Guide provides information on emergency work for traditional natural disasters.
FEMA HQ will most likely provide Covid-19 Disaster Specific Guidance in near future
Emergency protective measures conducted before, during, and after an incident are eligible if the measures:
Eliminate or lessen immediate threats to lives, public health, or safety; OR
Eliminate or lessen immediate threats of significant additional damage to improved public or private property in a cost-effective manner.
FEMA may require certification by Federal, State, Territorial, Tribal, or local government officials that a threat exists, including:
Identification and evaluation of the threat
Recommendations of the work necessary to cope with the threat
The HHS Centers for Disease Control and Prevention (CDC) has primary authority to enable support and assistance to States, Territorial, or Tribal Governments in response to an infectious disease event. FEMA may provide assistance for the rescue, evacuation, and movement of persons; movement of supplies; and care, shelter, and other essential needs of affected human populations.
Any assistance provided by FEMA in response to an infectious disease event is done in coordination with the CDC. The Office of Response and Recovery Fact Sheet FP 104009-001, Infectious Disease Event, provides additional details.
The exhibit below is from the FEMA PAPPG on emergency work.
Release date: March 31, 2020 Frequently Asked Questions
Subsequent to President Trump’s March 13, 2020, Nationwide Emergency Declaration for Coronavirus 2019 (COVID-19), the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) recognizes that non-congregate sheltering may be necessary in this Public Health Emergency to protect public health and save lives.
This document provides answers to frequently asked questions about non-congregate sheltering during the Secretary of Health and Human Services’ (HHS’) declaration of a Public Health Emergency for COVID-19.
The term “medical sheltering” is meant to address the specific needs directly resulting from this Public Health Emergency. For purposes of eligibility under the COVID-19 declarations, FEMA will consider non-congregate sheltering for health and medical-related needs, such as isolation and quarantine resulting from the public health emergency. Alternate care sites and temporary hospitals are not considered non-congregate sheltering and such requests should be routed through the proper channels. Please refer to the Emergency Medical Care for COVID-19 Fact Sheet.
Examples of target populations include those who test positive for COVID-19 who do not require hospitalization but need isolation (including those exiting from hospitals); those who have been exposed to COVID-19 who do not require hospitalization; and asymptomatic high-risk individuals needing social distancing as a precautionary measure, such as people over 65 or with certain underlying health conditions (respiratory, compromised immunities, chronic disease). Sheltering specific populations in non-congregate shelters should be determined by a public health official’s direction or in accordance with the direction or guidance of health officials by the appropriate state or local entities. The request should specify the populations to be sheltered. Non-congregate sheltering of healthcare workers and first responders who require isolation may be eligible when determined necessary by the appropriate state, local, tribal, or territorial public health officials and when assistance is not duplicated by another federal agency.
Sheltering solutions should be determined by the Applicant requesting assistance, such as hotels, motels, dormitories, or other forms of non-congregate sheltering. The solutions should meet the criteria of non-congregate sheltering for the COVID-19 emergency, including what is necessary to protect public health and safety, be in accordance with guidance provided by appropriate health officials, and be reasonable and necessary to address the threat to public health and safety.
The non-congregate sheltering must be at the direction of and documented through an official order signed by a state, local, tribal, or territorial public health official or be done in accordance with the direction or guidance of health officials by the appropriate state or local entities, in accordance with applicable state and local laws.
Yes, the delegation applies to all incidents declared as a result of COVID-19.
Yes, there is a template request letter that the Applicant can use. In addition, Template Project Worksheets are currently being developed. Please contact your Regional point of contact for additional information concerning the template.
Requests should be submitted based on the state and/or local public health orders, along with relevant public health guidance that recommends sheltering be conducted in the manner that is being requested for reimbursement and must meet the criteria of the guidance issued by FEMA for COVID-19. In instances where the state is issuing the public health order along with relevant public health guidance for non-congregate sheltering for the state, it is possible for FEMA to approve a state-wide request.
A state-wide non-congregate sheltering request should outline the state’s non-congregate sheltering plan with options that will be utilized in the state by local governments. Upon pre-approval of non-congregate sheltering, the state can be the sub-recipient, or a county/local government can be a sub-recipient.
Tracking mechanisms must be in place to provide data and documentation to establish the eligibility of costs for which the Applicant is requesting Public Assistance funding (including the need for non-congregate sheltering of each individual, length of stay, and costs). As with any activity, lack of support documentation may result in FEMA determining that some or all of the costs are ineligible.
In limited circumstances where the nature of the emergency did not make a request feasible prior to beginning non-congregate sheltering, the Regional Administrator may approve non-congregate sheltering after it has already commenced.
No, this delegation may not be re-delegated. The Regional Administrator should approve, partially approve, or deny the request in writing. This documentation should be uploaded to the project in FEMA Grants Manager.
Eligible costs related to sheltering should be necessary based on the type of shelter, the specific needs of those sheltered, and determined necessary to protect public health and safety and in accordance with guidance provided by appropriate health officials. However, support services such as case management, mental health counseling, and others are not eligible.
The length of non-congregate sheltering depends on the needs in each area and will be in accordance with the guidance and direction from appropriate health officials. Sheltering eligibility for sheltering activities may not extend beyond the state or local public health order or the HHS Public Health Emergency for COVID-19. Length of sheltering for individuals is based on health guidance and be limited to what is needed to address the immediate threat to public health and safety. The mission will depend on the level of community transmission in each area. Areas with high rates of community transmission, hospital admissions, and fatalities may need up to eight weeks. Reassessment at periodic intervals is necessary.
Regional Administrators should approve non-congregate sheltering in 30-day increments, or less if a re-assessment determines there is no longer a public health need, but not to exceed the duration of the order of the state or local public health officer. The state or local will need to provide a re-assessment of the continuing need for emergency non-congregate sheltering from a state public health official, as well as a detailed justification for the continuing need for emergency non-congregate sheltering. The non-congregate sheltering for an individual should be in accordance with the guidance and direction from appropriate health officials.
Sheltering in future events will need to conform to current guidelines in place, including considerations for shelter operations in a pandemic environment. If there are additional costs incurred for such shelter operations, FEMA may reimburse those costs as eligible under the subsequent declaration requiring the shelter operations.
FEMA cannot duplicate assistance provided by another Federal agency. In this case, HHS is providing funding for certain costs in response to the COVID-19 pandemic. Each Applicant will need to agree to the stipulation in the grant conditions of all FEMA awards that funding is not also being received from another funding source. FEMA is coordinating with HHS to share information about funding from each Agency to assist in the prevention of duplication of benefits.
Release date: March 19, 2020
Release Number: FACT SHEET
Under President Trump’s March 13, 2020, national emergency declaration for the coronavirus (COVID-19) pandemic, FEMA’s Regional Administrators have been delegated
authority to approve requests for non-congregate sheltering for the duration of the Secretary of Health and Human Services’ declaration of a Public Health Emergency for
COVID-19.
In accordance with section 502 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, eligible emergency protective measures taken to respond to the COVID-19 emergency at the direction or guidance of state,
local, tribal, and territorial public health officials may be reimbursed under Category B of FEMA’s Public Assistance program.
FEMA recognizes that non-congregate sheltering may be necessary in this Public Health Emergency to save lives, to protect property and public health, and to ensure public safety, as well as to lessen or avert the threat of a
catastrophe. States, tribes and territories should work with their regional administrators for approval of noncongregate sheltering and procure the necessary support services needed to meet the needs of the public health
emergency. The following criteria must be considered before setting up non-congregate sheltering and supportservices:
Last Updated: March 19, 2020 - 14:05
Release date: April 12, 2020 Release Number: FEMA Policy FP 104-010-03
Under the President’s March 13, 2020, COVID-19 emergency declaration 1 and subsequent major disaster declarations for COVID-19, state, local, tribal, and territorial (SLTT) government entities and certain private non-profit (PNP) organizations are eligible to apply for assistance under the FEMA Public Assistance (PA) Program. This policy is applicable to eligible PA applicants only and is exclusive to emergency and major disaster declarations for the COVID- 19 pandemic.
As of April 9, 2020, 51 states and territories had “stay at home” orders in place.2 The population at high-risk for severe illness from COVID-19 includes people 65 years and older and people of any age who have serious underlying medical conditions, including people with chronic lung disease or moderate to severe asthma, people with serious heart conditions, people who are immunocompromised (e.g., those undergoing cancer treatment, smokers, those with HIV or AIDS), and people with severe obesity, diabetes, or liver disease, and people undergoing kidney dialysis.3 Due to the impact of the COVID-19 pandemic, there may be areas where it will be necessary as an emergency protective measure to provide food to meet the immediate needs of those who do not have access to food as a result of COVID-19 and to protect the public from the spread of the virus.
This policy defines the framework, policy details, and requirements for determining eligible work and costs for the purchase and distribution of food in response to the COVID-19 Public Health Emergency to ensure consistent and appropriate implementation across all COVID-19 emergency and major disaster declarations. Except where specifically stated otherwise in this policy, assistance is subject to PA Program requirements as defined in Version 3.1 of the Public Assistance Program and Policy Guide (PAPPG).4
1. This policy applies to:
Outcome: To define the overarching eligibility framework for purchasing and distributing food in response to COVID-19 declarations.
1. Legal Responsibility.
2. Work Eligibility.
3. Cost Eligibility.
4. Time Limitations.
Keith Turi
Assistant Administrator, Recovery Directorate
Date: April 11, 2020